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Cigarette Smoking: Health Risks and How to Quit (PDQ®)

Significance

In the United States, smoking-related illnesses accounted for an estimated
480,000 deaths each year.[1,2] (Also available online.) On average, these deaths occur 12 years earlier than would
be expected, so the aggregate annual loss exceeds 5 million life-years.[3] These
deaths are primarily due to smoking’s role as a major cause of cancer, cardiovascular diseases,
and chronic lung diseases. The known adverse health effects also include other respiratory diseases and symptoms, nuclear cataract, hip fractures, reduced female fertility, and diminished health status. Maternal smoking during pregnancy is associated with fetal growth restriction, low birth weight, and complications of pregnancy.[4] It has been estimated that about 30% of
cancer deaths and 20% of all premature deaths in the United States are
attributable to smoking.[1]

Tobacco products are the single, major avoidable cause of cancer, causing more than
155,000 deaths among smokers in the United States annually due to various
cancers.[5] The majority of cancers of the lung, trachea, bronchus, larynx,
pharynx, oral cavity, nasal cavity, and esophagus are attributable to tobacco products, particularly cigarettes. Smoking is also causally associated with cancers of the pancreas, kidney, bladder, stomach, and
cervix and with myeloid leukemia.[4,6]

Environmental tobacco smoke has the
same components as inhaled mainstream smoke, although in lower absolute
concentrations, between 1% and 10%, depending on the constituent. Carcinogenic
compounds in tobacco smoke include the polycyclic aromatic hydrocarbons (PAHs),
including the carcinogen benzo[a]pyrene (BaP) and the nicotine-derived
tobacco-specific nitrosamine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone
(NNK).[8]
Elevated biomarkers of tobacco exposure, including urinary cotinine,
tobacco-related carcinogen metabolites, and carcinogen-protein adducts, are
seen in passive or secondhand smokers.[7,9-11]

In 2013, 20.5% of adult men and 15.3% of adult women in the United States were
current smokers.[2] (Also available online.) Cigarette smoking is particularly common among American
Indians and Alaska Natives. The prevalence of smoking also varies inversely
with education, and was highest among adults who had earned a General Educational Development diploma (41.4%) and generally decreased with increasing years of education.[2] (Also available online.) From 2000 to 2011, significant declines occurred in the use of cigarettes among middle school (10.7% to 4.3 %) and high school (27.9% to 15.8%) students.[12] (Also available online.) Cigarette smoking prevalence among male and
female high school students increased substantially during the early 1990s in
all ethnic groups but appears to have been declining since approximately 1996.[13,14] (Also available online.)

The effect of tobacco use on population-level health outcomes is illustrated
by the example of lung cancer mortality trends. Smoking by women increased
between 1940 and the early 1960s, resulting in a greater than 600% increase in
female lung cancer mortality since 1950. Lung cancer is now the leading cause
of cancer death in women.[13,15] In the last 30 years, prevalence of current
cigarette use has generally decreased, though far more rapidly in males. Lung
cancer mortality in men peaked in the 1980s, and has been declining since then; this
decrease has occurred predominantly in squamous cell and small cell carcinomas,
the histologic types most strongly associated with smoking.[13] Variations in
lung cancer mortality rates by state also more or less parallel long-standing
state-specific differences in tobacco use. Among men, the average
annual age-adjusted lung cancer death rates from 2001 to 2005 were highest in
Kentucky (111.5 per 100,000), where 29.1% of men were current smokers in 1997,
and lowest in Utah (33.7 per 100,000), where only 10.4% of men smoked. Among
women, lung cancer death rates were highest in Kentucky (55.9 per 100,000), where
28.0% of women were current smokers, and lowest in Utah (16.9 per 100,000),
where only 9.3% of women smoked.[13]

U.S. Department of Health and Human Services: The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Ga: U.S. Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available online. Last accessed January 30, 2015.

Centers for Disease Control and Prevention: Targeting Tobacco Use: The Nation's Leading Cause of Death 2005. Atlanta, Ga: CDC, 2005.

Ontario Task Force on the Primary Prevention of Cancer: Recommendations for the Primary Prevention of Cancer. Toronto, Canada: Queen's Printer for Ontario, 1995.

U.S. Department of Health and Human Services: The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, Ga: U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. Also available online. Last accessed January 30, 2015.